CS/HB 7103

1
A bill to be entitled
2An act relating to mental health; creating s. 394.9086,
3F.S.; creating the Community Mental Health and Substance
4Abuse Treatment and Crime Reduction Act; providing
5legislative findings and intent; providing goals for the
6community mental health and substance abuse forensic
7treatment system; defining terms; requiring the Department
8of Children and Family Services, in consultation with the
9Agency for Health Care Administration, to develop and
10implement a community mental health and substance abuse
11forensic treatment system; providing initiatives and
12strategies for the community forensic system; detailing
13the services required in the community forensic system;
14setting forth the eligibility criteria for treatment in
15the system; requiring the department to develop a
16continuum of services to implement the Community Mental
17Health and Substance Abuse Treatment and Crime Reduction
18Act; specifying the services and functions the department
19must undertake; authorizing the department and the agency
20to identify pilot sites within the state where the
21community mental health and substance abuse forensic
22treatment system will be implemented; amending s. 394.655,
23F.S.; providing additional functions of the Criminal
24Justice, Mental Health, and Substance Abuse Policy
25Council; amending s. 394.656, F.S.; requiring the
26department and the agency to cooperate with counties that
27receive grants funding under the Criminal Justice, Mental
28Health, and Substance Abuse Reinvestment Grant Program;
29amending s. 394.657, F.S.; requiring county councils to
30consult with local government when planning or
31implementing the Community Mental Health and Substance
32Abuse Treatment and Crime Reduction Act; amending s.
33394.659, F.S.; requiring the Criminal Justice, Mental
34Health, and Substance Abuse Technical Assistance Center at
35the Louis de la Parte Florida Mental Health Institute at
36the University of South Florida to perform certain
37functions with respect to implementing the act; amending
38s. 409.906, F.S.; adding home and community-based mental
39health services to the optional Medicaid services offered
40by the state Medicaid program; amending s. 409.912, F.S.;
41allowing an exemption for persons who have serious and
42persistent mental illnesses and who are receiving services
43under the Community Mental Health and Substance Abuse
44Crime Reduction Act from MediPass and managed care plans;
45amending s. 916.107, F.S.; specifying treatment procedures
46for a client admitted to a state forensic mental health
47treatment facility who lacks the capacity to make an
48informed decision regarding mental health treatment at the
49time of admission; amending s. 916.111, F.S.; providing
50for forensic evaluator training for mental health experts;
51amending s. 916.115, F.S.; requiring court-appointed
52experts to have completed forensic evaluator training;
53requiring the court-appointed expert to be a psychiatrist
54or a licensed psychologist; requiring the Department of
55Children and Family Services to maintain and annually
56provide the courts with a forensic evaluator registry;
57amending s. 916.13, F.S.; providing timeframes for
58competency hearings to be held; amending s. 916.15, F.S.;
59providing timeframes for commitment hearings to be held;
60amending s. 916.17, F.S.; requiring that certain
61defendants be placed in a community residential facility
62for competency restoration in demonstration areas
63established under the Community Mental Health and
64Substance Abuse Treatment and Crime Reduction Act;
65providing exceptions; amending s. 985.19, F.S.; requiring
66that appointed experts complete the forensic evaluator
67training program; providing a contingent effective date.
68
69Be It Enacted by the Legislature of the State of Florida:
70
71     Section 1.  Section 394.9086, Florida Statutes, is created
72to read:
73     394.9086  Community Mental Health and Substance Abuse
74Treatment and Crime Reduction Act.--
75     (1)  LEGISLATIVE FINDINGS AND INTENT.--The Legislature
76finds that many jail inmates who have serious mental illnesses
77and who are committed to state forensic mental health treatment
78facilities for competency restoration could be served more
79effectively and at less cost in community-based alternative
80programs. The Legislature further finds that many people who
81have serious mental illnesses and who have been discharged from
82state forensic mental health treatment facilities could avoid
83recidivism to the criminal justice and forensic mental health
84systems if they received specialized treatment in the community.
85Therefore, it is the intent of the Legislature to create the
86Community Mental Health and Substance Abuse Treatment and Crime
87Reduction Act to serve individuals who have mental illnesses or
88co-occurring mental illnesses and substance abuse disorders and
89who are involved in or at risk of entering state forensic mental
90health treatment facilities, prisons, jails, juvenile justice
91centers, or state civil mental health treatment facilities.
92     (2)  GOALS.--The goals of the community mental health and
93substance abuse forensic treatment system are to:
94     (a)  Ensure public safety.
95     (b)  Ensure that services to restore forensic competency
96are provided in the least restrictive, least costly, and most
97effective environment.
98     (c)  Provide competency-restoration services in the
99community when appropriate, based on consideration of public
100safety, needs of the individual, and available resources.
101     (d)  Reduce admissions for competency restoration to state
102forensic mental health treatment facilities.
103     (e)  Reduce rates of arrest, incarceration, and
104reincarceration.
105     (f)  Increase outreach and services to individuals at risk
106for involvement in the criminal justice, juvenile justice, or
107forensic mental health systems.
108     (g)  Support collaboration among state and local
109stakeholders, including law enforcement agencies, courts, state
110agencies, jails, county government, service providers,
111individuals with mental illnesses or co-occurring mental
112illnesses and substance abuse disorders, family members,
113advocates, and other community members.
114     (3)  DEFINITIONS.--As used in this section, the term:
115     (a)  "Best practices" means treatment services that
116incorporate the most effective and acceptable interventions
117available in the care and treatment of individuals who are
118diagnosed as having a mental illness or a co-occurring mental
119illness and substance abuse disorder.
120     (b)  "Community forensic system" means the community mental
121health and substance abuse forensic treatment system, including
122the comprehensive set of services and supports provided to
123individuals involved in or at risk of becoming involved in the
124criminal justice system.
125     (c)  "Community residential facility" means a community-
126based residential treatment setting licensed by the agency under
127s. 394.875 or s. 429.075, or the department under s. 397.401.
128     (d)  "Evidence-based practices" means interventions and
129strategies that, based on the best available empirical research,
130demonstrate effective and efficient outcomes in the care and
131treatment of individuals who are diagnosed as having mental
132illnesses or co-occurring mental illnesses and substance use
133disorders.
134     (e)  "Forensic intensive care management" means activities
135addressing the comprehensive psychiatric, social, and support
136needs of individuals who are diagnosed as having serious and
137persistent mental illnesses, co-occurring disorders, or severe
138emotional disturbances, and who are involved in the justice
139system and receiving services under this section. Activities
140include, but are not limited to, service planning, service
141coordination, monitoring, and assistance with accessing federal,
142state, and local benefits necessary to sustain a person in the
143community.
144     (f)  "Geographic area" means a county, circuit, regional,
145or multiregional area in this state.
146     (4)  SERVICE SYSTEM.--The department, in consultation with
147the agency, shall develop and implement a community mental
148health and substance abuse forensic treatment system. The
149community forensic system must build on local community
150diversion and reentry initiatives and strategies that are
151consistent with those identified and supported under s.
152394.658(1).
153     (a)  The community forensic system initiatives and
154strategies may include, but are not limited to:
155     1.  Mental health courts.
156     2.  Diversion programs.
157     3.  Alternative prosecution and sentencing techniques.
158     4.  Crisis intervention teams.
159     5.  Specialized training for criminal justice, juvenile
160justice, and treatment services professionals.
161     6.  Specialized probation officers at the state and county
162levels to serve individuals under correctional control in the
163community.
164     7.  Collateral services such as supported, transitional,
165and permanent housing, and supported employment.
166     8.  Reentry services to create or expand mental health and
167co-occurring treatment and supports for affected individuals.
168     (b)  The community forensic system must include a
169comprehensive continuum of care and services that use evidence-
170based and best practices to address co-occurring mental health
171and substance abuse disorders. The community forensic system
172must include the following minimum services and elements:
173     1.  Competency-restoration and treatment services provided
174in a variety of settings from least restrictive to progressively
175more restrictive settings.
176     2.  Forensic intensive care management.
177     3.  Supported housing.
178     4.  Supported employment.
179     5.  Medication management.
180     6.  Trauma-specific services for treatment of the effects
181of sexual, physical, and emotional abuse or trauma experienced
182by individuals who have mental illnesses and are involved in the
183criminal justice system.
184     7.  Residential services to address crisis episodes and
185short-term residential treatment.
186     8.  Treatment for co-occurring mental health and substance
187use disorders.
188     9.  Outreach and education for individuals and their
189families who are at risk of further involvement with the justice
190system.
191     10.  Utilization of involuntary outpatient placement for
192individuals meeting the criteria as provided under s. 394.4655
193and conditional release for individuals adjudicated incompetent
194to proceed due to mental illness or not guilty by reason of
195insanity as provided under s. 916.17.
196     11.  Other services or supports as identified.
197     (5)  ELIGIBILITY.--The department may serve individuals who
198meet the criteria in this subsection. The department must give
199highest priority for services under this section to:
200     (a)  Adults who are adjudicated incompetent to proceed or
201not guilty by reason of insanity under chapter 916 and ordered
202by the court into forensic commitment, whose current most
203serious charge is a felony of the third degree or a felony of
204the second degree if the felony did not involve violence, and
205who meet public safety criteria established by the court and
206treatability criteria established by the department for
207placement in a community setting.
208     (b)  Adults who experience serious and persistent mental
209illnesses reentering the community from state prisons.
210     (c)  Adults who have been committed to a state forensic
211mental health treatment facility after being adjudicated
212incompetent to proceed or not guilty by reason of insanity, and
213who are released or who are pending release to the community by
214the court after completing competency restoration services or
215being found to no longer meet the criteria for continued
216commitment placement.
217     (d)  Adults who experience serious and persistent mental
218illnesses, who have a history of involvement in the justice
219system, or who are at risk of entering or who are already
220involved with the criminal justice system.
221     (e)  Children deemed incompetent to proceed under s.
222985.19.
223     (6)  DEPARTMENT RESPONSIBILITIES.--The department shall
224develop a continuum of services to implement the Community
225Mental Health and Substance Abuse Treatment and Crime Reduction
226Act in accordance with subsection (4). The department shall:
227     (a)  Define requirements for all providers in the community
228forensic system.
229     (b)  Select demonstration sites for participation, based on
230criteria in subsection (7), which demonstrate active and
231sustained participation in community collaborations.
232     (c)  Enter into memoranda of agreement with county planning
233councils or committees identified in s. 394.657, which are
234included in the demonstration sites.
235     (d)  Identify providers to implement the continuum of
236services. The department shall consult with county planning
237councils or committees in the selection process.
238     (e)  Establish performance measures and reporting
239requirements for providers participating in the community
240forensic system. The measures shall include, at a minimum:
241     1.  The number of individuals diverted from state forensic
242mental health treatment facilities.
243     2.  The number of individuals diverted from the criminal
244justice system.
245     3.  The rates of arrest, incarceration, and reincarceration
246for new criminal offenses.
247     4.  The rates of employment.
248     5.  The annual number of days in a crisis stabilization
249unit, detoxification facility, short-term residential treatment
250program, state civil mental health treatment facility, or state
251forensic mental health treatment facility.
252     (f)  Monitor contracts for compliance with terms, and at
253least annually and to the extent possible, perform joint onsite
254monitoring with the agency and the Criminal Justice, Mental
255Health, and Substance Abuse Technical Assistance Center
256established under s. 394.659 to assess performance of the
257contract.
258     (7)  IMPLEMENTATION.--The department is authorized to
259implement this section within available resources. In
260expectation of statewide implementation of this section, the
261department, in consultation with the agency, may identify three
262pilot sites, one to be located one in each of the northwest,
263southern, and Tampa Bay areas of the state for the initial
264implementation. Each site must be selected based on findings of
265community readiness and the potential for affecting the greatest
266number of individuals entering the forensic mental health and
267criminal justice systems. Criteria for selection may include:
268     (a)  Community readiness to deliver the services outlined
269in subsection (4), demonstrated by well-established community
270collaboration plans and local partnerships as evidenced by
271memoranda of agreement that are submitted to and approved by the
272department.
273     (b)  A high bed-utilization rate at state forensic mental
274health treatment facilities.
275     (c)  Successful application for implementation grant
276funding under the Criminal Justice, Mental Health, and Substance
277Abuse Reinvestment Grant Program.
278     (d)  Other elements determined by the department in
279consultation with the agency.
280     Section 2.  Paragraph (b) of subsection (11) of section
281394.655, Florida Statutes, is amended to read:
282     394.655  The Substance Abuse and Mental Health Corporation;
283powers and duties; composition; evaluation and reporting
284requirements.--
285     (11)
286     (b)  The purpose of the council shall be to:
287     1.  Align policy initiatives in the criminal justice,
288juvenile justice, and mental health, and substance abuse systems
289to ensure the most effective use of resources and to coordinate
290the development of legislative proposals and budget requests
291relating to the shared needs of adults and juveniles who have a
292mental illness, substance abuse disorder, or co-occurring mental
293health and substance abuse disorders who are in, or at risk of
294entering, the criminal justice system.
295     2.  Provide consultation in the development of
296comprehensive and cost-effective community-based mental health
297and substance abuse treatment services for individuals who have
298mental illnesses and who are receiving services in state
299forensic mental health treatment facilities, juvenile secure
300residential treatment centers specializing in competency
301training, prisons, jails, and juvenile justice centers. The
302council shall appoint an advisory committee to review and
303monitor the implementation of the Community Mental Health and
304Substance Abuse Treatment and Crime Reduction Act. The advisory
305committee shall include at least one person who has received
306services and one family member of a person who has received
307services under this section.
308     Section 3.  Subsection (1) of section 394.656, Florida
309Statutes, is amended to read:
310     394.656  Criminal Justice, Mental Health, and Substance
311Abuse Reinvestment Grant Program.--
312     (1)  There is created within the Department of Children and
313Family Services the Criminal Justice, Mental Health, and
314Substance Abuse Reinvestment Grant Program. The purpose of the
315program is to provide funding to counties with which they can
316plan, implement, or expand initiatives that increase public
317safety, avert increased spending on criminal justice, and
318improve the accessibility and effectiveness of treatment
319services for adults and juveniles who have a mental illness,
320substance abuse disorder, or co-occurring mental health and
321substance abuse disorders and who are in, or at risk of
322entering, the criminal or juvenile justice systems. In
323implementing the Community Mental Health and Substance Abuse
324Treatment and Crime Reduction Act, the department and agency
325shall work in coordination with counties that received grants
326under the Criminal Justice, Mental Health, and Substance Abuse
327Reinvestment Grant Program to develop local treatment and
328service delivery infrastructures.
329     Section 4.  Subsection (1) of section 394.657, Florida
330Statutes, is amended to read:
331     394.657  County planning councils or committees.--
332     (1)  Each board of county commissioners shall designate the
333county public safety coordinating council established under s.
334951.26, or designate another criminal or juvenile justice mental
335health and substance abuse council or committee, as the planning
336council or committee. The public safety coordinating council or
337other designated criminal or juvenile justice mental health and
338substance abuse council or committee shall:,
339     (a)  Coordinate in coordination with the county offices of
340planning and budget to, shall make a formal recommendation to
341the board of county commissioners regarding how the Criminal
342Justice, Mental Health, and Substance Abuse Reinvestment Grant
343Program may best be implemented within a community. The board of
344county commissioners may assign any entity to prepare the
345application on behalf of the county administration for
346submission to the corporation for review. A county may join with
347one or more counties to form a consortium and use a regional
348public safety coordinating council or another county-designated
349regional criminal or juvenile justice mental health and
350substance abuse planning council or committee for the geographic
351area represented by the member counties.
352     (b)  Consult with local governing bodies when planning or
353implementing the Community Mental Health and Substance Abuse
354Treatment and Crime Reduction Act.
355     Section 5.  Paragraphs (g), (h), (i), and (j) are added to
356subsection (1) of section 394.659, Florida Statutes, to read:
357     394.659  Criminal Justice, Mental Health, and Substance
358Abuse Technical Assistance Center.--
359     (1)  There is created a Criminal Justice, Mental Health,
360and Substance Abuse Technical Assistance Center at the Louis de
361la Parte Florida Mental Health Institute at the University of
362South Florida, which shall:
363     (g)  In coordination with the department, develop minimum
364competencies and proficiencies required for communities and
365service providers.
366     (h)  Identify evidence-based and best practices and deliver
367necessary training and consultation to service providers.
368     (i)  Assist the department in developing outcome measures.
369     (j)  Provide an annual report by October 1 to the Governor,
370the President of the Senate, the Speaker of the House of
371Representatives, the Chief Justice of the Florida Supreme Court,
372and the State Courts Administrator on the status of
373implementation of the Community Mental Health and Substance
374Abuse Treatment and Crime Reduction Act. For those areas also
375required to make a report under subsection (2) concerning a
376grant, the institute shall prepare a joint report to avoid
377duplication.
378     Section 6.  Subsection (28) is added to section 409.906,
379Florida Statutes, to read:
380     409.906  Optional Medicaid services.--Subject to specific
381appropriations, the agency may make payments for services which
382are optional to the state under Title XIX of the Social Security
383Act and are furnished by Medicaid providers to recipients who
384are determined to be eligible on the dates on which the services
385were provided. Any optional service that is provided shall be
386provided only when medically necessary and in accordance with
387state and federal law. Optional services rendered by providers
388in mobile units to Medicaid recipients may be restricted or
389prohibited by the agency. Nothing in this section shall be
390construed to prevent or limit the agency from adjusting fees,
391reimbursement rates, lengths of stay, number of visits, or
392number of services, or making any other adjustments necessary to
393comply with the availability of moneys and any limitations or
394directions provided for in the General Appropriations Act or
395chapter 216. If necessary to safeguard the state's systems of
396providing services to elderly and disabled persons and subject
397to the notice and review provisions of s. 216.177, the Governor
398may direct the Agency for Health Care Administration to amend
399the Medicaid state plan to delete the optional Medicaid service
400known as "Intermediate Care Facilities for the Developmentally
401Disabled." Optional services may include:
402     (28)  HOME AND COMMUNITY-BASED SERVICES.--The agency,
403contingent upon appropriation of funds for this purpose, may
404seek federal approval through a state plan amendment to
405implement home and community-based services under the authority
406of and in compliance with s. 1915i of the Social Security Act
407for services provided to individuals who have been determined by
408an independent evaluation to have disabilities that cause them
409to become, or put them at risk of becoming, involved with the
410criminal justice system due to their mental illness. In
411accordance with allowances under s. 1915i of the Social Security
412Act, these services may be limited to a select number of
413eligible individuals in select geographic areas, as identified
414by the agency. Eligible individuals may have incomes up to 150
415percent of the federal poverty level. The agency shall
416coordinate with the department to select and define the services
417that will be submitted in the state plan amendment and be
418provided under this subsection. The agency may disenroll from
419enrollment in MediPass, or any capitated or other Medicaid
420managed care arrangements, those individuals receiving services
421under this subsection. Enrollment in state plan services may not
422exceed 1,000 individuals unless additional approval is obtained
423from the Legislature. The agency must receive approval from the
424Legislature or Legislative Budget Commission for any funding
425beyond that which is provided within initial implementation
426revenues. After July 1, 2012, the agency may consider seeking
427authority to capitate Medicaid behavioral health services under
428this subsection.
429     Section 7.  Subsection (54) is added to section 409.912,
430Florida Statutes, to read:
431     409.912  Cost-effective purchasing of health care.--The
432agency shall purchase goods and services for Medicaid recipients
433in the most cost-effective manner consistent with the delivery
434of quality medical care. To ensure that medical services are
435effectively utilized, the agency may, in any case, require a
436confirmation or second physician's opinion of the correct
437diagnosis for purposes of authorizing future services under the
438Medicaid program. This section does not restrict access to
439emergency services or poststabilization care services as defined
440in 42 C.F.R. part 438.114. Such confirmation or second opinion
441shall be rendered in a manner approved by the agency. The agency
442shall maximize the use of prepaid per capita and prepaid
443aggregate fixed-sum basis services when appropriate and other
444alternative service delivery and reimbursement methodologies,
445including competitive bidding pursuant to s. 287.057, designed
446to facilitate the cost-effective purchase of a case-managed
447continuum of care. The agency shall also require providers to
448minimize the exposure of recipients to the need for acute
449inpatient, custodial, and other institutional care and the
450inappropriate or unnecessary use of high-cost services. The
451agency shall contract with a vendor to monitor and evaluate the
452clinical practice patterns of providers in order to identify
453trends that are outside the normal practice patterns of a
454provider's professional peers or the national guidelines of a
455provider's professional association. The vendor must be able to
456provide information and counseling to a provider whose practice
457patterns are outside the norms, in consultation with the agency,
458to improve patient care and reduce inappropriate utilization.
459The agency may mandate prior authorization, drug therapy
460management, or disease management participation for certain
461populations of Medicaid beneficiaries, certain drug classes, or
462particular drugs to prevent fraud, abuse, overuse, and possible
463dangerous drug interactions. The Pharmaceutical and Therapeutics
464Committee shall make recommendations to the agency on drugs for
465which prior authorization is required. The agency shall inform
466the Pharmaceutical and Therapeutics Committee of its decisions
467regarding drugs subject to prior authorization. The agency is
468authorized to limit the entities it contracts with or enrolls as
469Medicaid providers by developing a provider network through
470provider credentialing. The agency may competitively bid single-
471source-provider contracts if procurement of goods or services
472results in demonstrated cost savings to the state without
473limiting access to care. The agency may limit its network based
474on the assessment of beneficiary access to care, provider
475availability, provider quality standards, time and distance
476standards for access to care, the cultural competence of the
477provider network, demographic characteristics of Medicaid
478beneficiaries, practice and provider-to-beneficiary standards,
479appointment wait times, beneficiary use of services, provider
480turnover, provider profiling, provider licensure history,
481previous program integrity investigations and findings, peer
482review, provider Medicaid policy and billing compliance records,
483clinical and medical record audits, and other factors. Providers
484shall not be entitled to enrollment in the Medicaid provider
485network. The agency shall determine instances in which allowing
486Medicaid beneficiaries to purchase durable medical equipment and
487other goods is less expensive to the Medicaid program than long-
488term rental of the equipment or goods. The agency may establish
489rules to facilitate purchases in lieu of long-term rentals in
490order to protect against fraud and abuse in the Medicaid program
491as defined in s. 409.913. The agency may seek federal waivers
492necessary to administer these policies.
493     (54)  Persons who have serious and persistent mental
494illnesses, who are receiving services under the Community Mental
495Health and Substance Abuse Crime Reduction Act, and who are
496eligible for and receiving services under the state plan
497implemented under s. 1915i of the Social Security Act, as
498approved by the Centers for Medicare and Medicaid Services, may
499be exempt from MediPass and managed care plans authorized under
500this chapter, including capitated managed care plans authorized
501under s. 409.91211.
502     Section 8.  Paragraph (a) of subsection (3) of section
503916.107, Florida Statutes, is amended to read:
504     916.107  Rights of forensic clients.--
505     (3)  RIGHT TO EXPRESS AND INFORMED CONSENT.--
506     (a)  A forensic client shall be asked to give express and
507informed written consent for treatment. If a client refuses such
508treatment as is deemed necessary and essential by the client's
509multidisciplinary treatment team for the appropriate care of the
510client, such treatment may be provided under the following
511circumstances:
512     1.  In an emergency situation in which there is immediate
513danger to the safety of the client or others, such treatment may
514be provided upon the written order of a physician for a period
515not to exceed 48 hours, excluding weekends and legal holidays.
516If, after the 48-hour period, the client has not given express
517and informed consent to the treatment initially refused, the
518administrator or designee of the civil or forensic facility
519shall, within 48 hours, excluding weekends and legal holidays,
520petition the committing court or the circuit court serving the
521county in which the facility is located, at the option of the
522facility administrator or designee, for an order authorizing the
523continued treatment of the client. In the interim, the need for
524treatment shall be reviewed every 48 hours and may be continued
525without the consent of the client upon the continued written
526order of a physician who has determined that the emergency
527situation continues to present a danger to the safety of the
528client or others.
529     2.  In a situation other than an emergency situation, the
530administrator or designee of the facility shall petition the
531court for an order authorizing necessary and essential treatment
532for the client.
533     a.  If the client has been receiving psychotherapeutic
534medication at the jail at the time of transfer to the state
535forensic mental health treatment facility and lacks the capacity
536to make an informed decision regarding mental health treatment
537at the time of admission, the admitting physician may order a
538continuation of the psychotherapeutic medication if, in the
539clinical judgment of the physician, abrupt cessation of the
540psychotherapeutic medication could cause a risk to the health
541and safety of the client during the time a court order to
542medicate is pursued. The jail physician shall provide a current
543psychotherapeutic medication order at the time of transfer to
544the admitting facility.
545     b.  The court order shall allow such treatment for a period
546not to exceed 90 days following the date of the entry of the
547order. Unless the court is notified in writing that the client
548has provided express and informed consent in writing or that the
549client has been discharged by the committing court, the
550administrator or designee shall, prior to the expiration of the
551initial 90-day order, petition the court for an order
552authorizing the continuation of treatment for another 90-day
553period. This procedure shall be repeated until the client
554provides consent or is discharged by the committing court.
555     3.  At the hearing on the issue of whether the court should
556enter an order authorizing treatment for which a client was
557unable to or refused to give express and informed consent, the
558court shall determine by clear and convincing evidence that the
559client has mental illness, retardation, or autism, that the
560treatment not consented to is essential to the care of the
561client, and that the treatment not consented to is not
562experimental and does not present an unreasonable risk of
563serious, hazardous, or irreversible side effects. In arriving at
564the substitute judgment decision, the court must consider at
565least the following factors:
566     a.  The client's expressed preference regarding treatment;
567     b.  The probability of adverse side effects;
568     c.  The prognosis without treatment; and
569     d.  The prognosis with treatment.
570
571The hearing shall be as convenient to the client as may be
572consistent with orderly procedure and shall be conducted in
573physical settings not likely to be injurious to the client's
574condition. The court may appoint a general or special magistrate
575to preside at the hearing. The client or the client's guardian,
576and the representative, shall be provided with a copy of the
577petition and the date, time, and location of the hearing. The
578client has the right to have an attorney represent him or her at
579the hearing, and, if the client is indigent, the court shall
580appoint the office of the public defender to represent the
581client at the hearing. The client may testify or not, as he or
582she chooses, and has the right to cross-examine witnesses and
583may present his or her own witnesses.
584     Section 9.  Section 916.111, Florida Statutes, is amended
585to read:
586     916.111  Training of mental health experts.--The evaluation
587of defendants for competency to proceed or for sanity at the
588time of the commission of the offense shall be conducted in such
589a way as to ensure uniform application of the criteria
590enumerated in Rules 3.210 and 3.216, Florida Rules of Criminal
591Procedure.
592     (1)  A forensic evaluator training course approved by the
593department must be provided at least annually to ensure that
594mental health professionals have the opportunity to be placed on
595the department's forensic evaluator registry.
596     (a)  Beginning July 1, 2010, experts shall remain on the
597registry if they have completed or retaken the required training
598within the previous 5 years. Those who have not completed the
599required training within the previous 5 years shall be removed
600from the registry and may not conduct evaluations for the
601courts.
602     (b)  A mental health professional who has completed the
603training course within the previous 5 years is responsible for
604maintaining documentation of completion of the required training
605and providing to the department current contact information.
606     (2)  The department shall develop, and may contract with
607accredited institutions:
608     (a)(1)  To provide:
609     1.(a)  A plan for training mental health professionals to
610perform forensic evaluations and to standardize the criteria and
611procedures to be used in these evaluations;
612     2.(b)  Clinical protocols and procedures based upon the
613criteria of Rules 3.210 and 3.216, Florida Rules of Criminal
614Procedure; and
615     3.(c)  Training for mental health professionals in the
616application of these protocols and procedures in performing
617forensic evaluations and providing reports to the courts; and
618     (b)(2)  To compile and maintain the necessary information
619for evaluating the success of this program, including the number
620of persons trained, the cost of operating the program, and the
621effect on the quality of forensic evaluations as measured by
622appropriateness of admissions to state forensic facilities and
623to community-based care programs.
624     Section 10.  Subsection (1) of section 916.115, Florida
625Statutes, is amended to read:
626     916.115  Appointment of experts.--
627     (1)  The court shall appoint no more than three experts to
628determine the mental condition of a defendant in a criminal
629case, including competency to proceed, insanity, involuntary
630placement, and treatment. The experts may evaluate the defendant
631in jail or in another appropriate local facility or in a
632facility of the Department of Corrections.
633     (a)  To the extent possible, The appointed experts shall
634have completed forensic evaluator training as provided in s.
635916.111 approved by the department, and each shall be a
636psychiatrist, or licensed psychologist, or physician.
637     (b)  The department shall maintain and annually provide the
638courts with a forensic evaluator registry list of available
639mental health professionals who have completed the approved
640training as experts.
641     Section 11.  Section 916.13, Florida Statutes, is amended
642to read:
643     916.13  Involuntary commitment of defendant adjudicated
644incompetent.--
645     (1)  Every defendant who is charged with a felony and who
646is adjudicated incompetent to proceed may be involuntarily
647committed for treatment upon a finding by the court of clear and
648convincing evidence that:
649     (a)  The defendant has a mental illness and because of the
650mental illness:
651     1.  The defendant is manifestly incapable of surviving
652alone or with the help of willing and responsible family or
653friends, including available alternative services, and, without
654treatment, the defendant is likely to suffer from neglect or
655refuse to care for herself or himself and such neglect or
656refusal poses a real and present threat of substantial harm to
657the defendant's well-being; or
658     2.  There is a substantial likelihood that in the near
659future the defendant will inflict serious bodily harm on herself
660or himself or another person, as evidenced by recent behavior
661causing, attempting, or threatening such harm;
662     (b)  All available, less restrictive treatment
663alternatives, including treatment in community residential
664facilities or community inpatient or outpatient settings, which
665would offer an opportunity for improvement of the defendant's
666condition have been judged to be inappropriate; and
667     (c)  There is a substantial probability that the mental
668illness causing the defendant's incompetence will respond to
669treatment and the defendant will regain competency to proceed in
670the reasonably foreseeable future.
671     (2)(a)  A defendant who has been charged with a felony and
672who has been adjudicated incompetent to proceed due to mental
673illness, and who meets the criteria for involuntary commitment
674to the department under the provisions of this chapter, may be
675committed to the department, and the department shall retain and
676treat the defendant. Within No later than 6 months after the
677date of admission and at the end of any period of extended
678commitment, or at any time the administrator or designee shall
679have determined that the defendant has regained competency to
680proceed or no longer meets the criteria for continued
681commitment, the administrator or designee shall file a report
682with the court pursuant to the applicable Florida Rules of
683Criminal Procedure.
684     (b)  Within 30 days after the court receives notification
685that a defendant is competent to proceed or no longer meets the
686criteria for continued commitment, the defendant shall be
687transported back to jail pursuant to s. 916.107(10) for the
688purpose of holding a competency hearing.
689     (c)  A competency hearing shall be held within 30 days
690after a court receives notification that the defendant is
691competent to proceed or no longer meets criteria for continued
692commitment.
693     Section 12.  Present subsection (4) of section 916.15,
694Florida Statutes, is renumbered as subsection (5), and a new
695subsection (4) is added to that section, to read:
696     916.15  Involuntary commitment of defendant adjudicated not
697guilty by reason of insanity.--
698     (4)(a)  Within 30 days after the court is notified that a
699defendant no longer meets the criteria for involuntary
700commitment placement, the defendant shall be transported back to
701jail for the purpose of holding a commitment hearing.
702     (b)  A commitment hearing shall be held within 30 days
703after the court receives notification that the defendant no
704longer meets the criteria for continued commitment placement.
705     Section 13.  Present subsections (2) and (3) of section
706916.17, Florida Statutes, are renumbered as subsections (3) and
707(4), respectively, and a new subsection (2) is added to that
708section, to read:
709     916.17  Conditional release.--
710     (2)  A defendant who otherwise meets the criteria for
711involuntary commitment under s. 916.13, but whose current most
712serious charge is a felony of the third degree or a felony of
713the second degree when the felony did not involve violence, must
714be placed in a community residential facility for competency
715restoration in pilot sites established in s. 394.9086, unless
716bed space or funding is unavailable for the community placement
717or the trial court makes an explicit finding that the defendant
718cannot be safely managed in such a placement. In making the
719determination under this subsection, the court shall consider
720all of the following:
721     (a)  The nature and seriousness of the crime allegedly
722committed.
723     (b)  The individual's criminal history.
724     (c)  The individual's psychiatric history.
725     (d)  The individual's history of violent behavior or
726threats of violent behavior and risk of harm to self or others.
727     (e)  The likelihood that the individual will comply with
728and benefit from the mental health treatment and services being
729recommended.
730     (f)  The availability of appropriate community-based
731services and treatment settings.
732     (g)  Other information considered relevant by the court.
733     Section 14.  Paragraphs (b) and (d) of subsection (1) of
734section 985.19, Florida Statutes, are amended to read:
735     985.19  Incompetency in juvenile delinquency cases.--
736     (1)  If, at any time prior to or during a delinquency case,
737the court has reason to believe that the child named in the
738petition may be incompetent to proceed with the hearing, the
739court on its own motion may, or on the motion of the child's
740attorney or state attorney must, stay all proceedings and order
741an evaluation of the child's mental condition.
742     (b)  All determinations of competency shall be made at a
743hearing, with findings of fact based on an evaluation of the
744child's mental condition made by not less than two nor more than
745three experts appointed by the court. The basis for the
746determination of incompetency must be specifically stated in the
747evaluation and must be conducted in such a way as to ensure
748uniform application of the criteria enumerated in Rule 8.095,
749Florida Rules of Juvenile Procedure. In addition, a
750recommendation as to whether residential or nonresidential
751treatment or training is required must be included in the
752evaluation. Experts appointed by the court to determine the
753mental condition of a child shall be allowed reasonable fees for
754services rendered. State employees may be paid expenses pursuant
755to s. 112.061. The fees shall be taxed as costs in the case.
756     (d)  Appointed experts must have completed forensic
757evaluator training approved by the Department of Children and
758Family Services within 5 years prior to conducting evaluations
759for the court, and each must be a psychiatrist or licensed
760psychologist. For incompetency evaluations related to mental
761illness, the Department of Children and Family Services shall
762maintain and annually provide the courts with a list of
763available mental health professionals who have completed a
764training program approved by the Department of Children and
765Family Services to perform the evaluations.
766     1.  Beginning July 1, 2010, experts shall remain on the
767registry if they have completed or retaken the required training
768within the previous 5 years. Those who have not completed the
769required training within the previous 5 years shall be removed
770from the registry and may not conduct evaluations for the
771courts.
772     2.  A mental health professional who has completed the
773training course within the previous 5 years is responsible for
774maintaining documentation of completion of the required training
775and providing to the Department of Children and Family Services
776current contact information.
777     Section 15.  This act shall take effect July 1, 2009, only
778if a specific appropriation to fund the provisions of this act
779is made in fiscal year 2009-2010.


CODING: Words stricken are deletions; words underlined are additions.